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Author

  • Klemens B.Meyer

  • Stephen G. Pauker

Publisher

  • The New England Journal of Medicine

Category

  • HIV Tests

Topic

  • HIV Test Accuracy

Article Type

  • Editorial Article

Publish Year

  • 1987

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Meta Description

  • The content discusses HIV testing, highlighting issues of false positives and the need for better methods. It references various studies and conferences on AIDS.

Summary

  • The content discusses the challenges and considerations surrounding the expansion of HIV testing programs. It emphasizes the need for standardization, quality control, and ongoing monitoring of laboratory performance. The author raises questions about the scientific, political, legal, and philosophical implications of HIV screening, including issues of confidentiality, testing accuracy, and the balance between sensitivity and specificity. The content also highlights potential problems with decentralized testing and interlaboratory variation. It concludes by cautioning against hasty and indiscriminate screening, urging careful consideration of the trade-offs and potential consequences of widespread testing.

Meta Tag

  • HIV

  • Screening

  • Testing

  • False Positive

  • Quality Control

  • Infection

  • Laboratories

  • AIDS

  • Prevalence

  • Sensitivity

  • Specificity

  • Standardization

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By Klemens B.Meyer and Stephen G. Pauker
The New England Journal of Medicine
Vol. 317 No. 4 / July 23, 1987

...

       The AIDS epidemic frightens us all. But we should not allow our fear to cloud our judgment. Hasty and indiscriminate screening for antibody to HIV is imprudent and potentially dangerous, whether we suggest the tests to young women, require them of engaged couples, or impose them on our veterans. Although screening of blood donors and military recruits appears to have generated few false positive results, we do not know whether this performance can continue if the testing programs are expanded. Standardization and quality control should come first. These will take time and money; monitoring laboratory performance will require continuing effort, expenditure, and regulation.
        Nor will our problems be purely technical. HIV screening poses questions that are at once scientific, political, legal, and philosophical. If laws are to link our fates to test results, should not due process be brought to the benches where those tests are performed? We will need guarantees not only of the confidentiality of test results but also of the quality of the testing procedure. Should everyone be subjected to tests of uniform sensitivity and specificity, or should performance characteristics be tailored to the clinical situation? Should screening programs in the general population sacrifice specificity by adopting the highly sensitive tests designed to protect the blood supply? In the past, inexplicably positive results in persons at no apparent risk of HIV infection prompted extensive investigation of the specimens in research laboratories. Wider screening will inevitably yield more unanticipated positive results - perhaps far more than researchers can review. How will we decide whose positive results we scrutinize? Who will weigh the scientific evidence against the skepticism of the person who does not believe his positive test results? Will we recognize the results of tests performed in other countries? How often will we retest and reclassify on the basis of technical advances or because of the passage of time?
        If we want to test each other, we should make a deliberate choice of the threshold probability of infection above which we will screen. We should make explicit the trade-offs implicit in any testing program. How many engagements should end to prevent one infection? How many jobs should be lost? How many insurance policies should be canceled or denied? How many fetuses should be aborted and how many couples should remain childless to avert the birth of one child with AIDS?

New England Medical Center        
Boston, MA 02111

KLEMENS B.MEYER, M.D.
STEPHEN G. PAUKER, M.D.

Supported in part by a training grant (7044) and a research grant (4493) from the National Library of Medicine, Bethesda, Md.

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